In-Vitro Fertilization

IVF and why it may be applicable to you

By: Maya Goyal

September 20, 2021

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It is human nature to plan for anything that comes our way. We are designed to be neurotic engineers of preparation. What if I told you there are factors in our life that are out of our control? Your reproductive journey is one that will be full of unexpected curveballs and at RepLI, we are here to help you navigate this journey with as much control as possible.

In this article, I will explore in vitro fertilization, which is also known as IVF. I will summarize situations it may be used and detail the reproductive journey of a young couple whose unique situation drove them to consider IVF.

WHAT IS IT?

In vitro fertilization is a form of ART or assisted reproductive technology. According to the CDC, ART is defined as any fertility treatment in which eggs or embryos are handled. ART is a broad categorization for infertility alternatives in which IVF is one branch, but it is the most common and effective form. IVF also breaks down into multiple further branches and approaches, but I will begin by explaining the general methodology behind infertility.

When battling infertility, couples first commonly explore fertility methods such intrauterine insemination and laparoscopy. Infertility can be stimulated from either the male or female side. So, these methods normally assist both genders either through hormone adjustments or surgery.

Intrauterine insemination involves the injection of sperm into the uterus which can increase the chance of fertilization, as pictured to the left. This method helps situations in which the male sperm contribution is stunted. It is minimally invasive and moderately affordable, making it an ideal and easy first step.

Another option is minor surgery. A laparoscopy is to observe organs more closely in your abdomen. This is considered an infertility treatment because in some cases, infertility can be prompted by growths on the uterus. These can block the sperm from meeting the egg. These growths (or fibroids) are common since they can result from surgeries, any infection, or inflammatory response. If a growth is found, removal is possible during the laparoscopy and will consequently increase the mobility for sperm within the uterus and fallopian tube.

If these options are deemed unsuccessful, couples turn to IVF, which can be a more definite alternative for infertility. IVF works using a variety of procedures and medications to first assist with sperm fertilization of the egg, and then implant the egg into the uterus.

HOW DOES IT WORK?

IVF can be broken down into 5 different stages:

1. The first step is ovulation induction where the female’s ovaries are essentially driven into overtime to increase fertility chances. Normally, one egg is dropped per month, but this step aims to produce several. This is initiated by medicines that boost egg production through the release of excess hormones. Then, when the time comes for egg retrieval, medication is taken to mature the eggs and prevent the body from releasing the eggs too soon.

2. The second step is egg retrieval in which minimally invasive surgery is performed to extract eggs from the female. Most commonly, a needle is inserted into the ovary and pulls eggs out of each follicle. In some cases, an ultrasound may be used to assist navigation, or donated eggs are used if the female cannot produce sufficient eggs. The retrieved eggs are then placed in an incubator. Throughout the first two steps, ultrasounds and blood tests are performed to monitor the patient’s well-being and catch any deficiencies.

3. The third step is sperm retrieval, which can be obtained as a semen sample from the partner or a donor sperm. The collected sample is separated in a lab to remove excess liquid.

4. Next comes fertilization either through conventional insemination or intracytoplasmic sperm injection (ICSI). The first mixes the egg and sperm and places it into an incubator. ICSI individually injects one sperm into each egg. The latter is more tedious but is used in instances where the quality of either component is compromised.

5. Embryo transfer is the final step. A catheter and syringe will be used to inject one or more embryos into your uterus through the vagina. An implanted egg about 6-10 days after egg retrieval indicates a successful transfer. Approximately one week after, a blood pregnancy test is performed to determine the result of the IVF.

WHY MIGHT I CONSIDER IT?

IVF is explored in the case of infertility. To test infertility, male sperm normally are analyzed for their health. Women are tested for normal hormone levels and regular ovulation, both of which affect how a sperm might meet an egg in the body. The fallopian tubes can also be affected or damaged. All these complications can be triggered by several factors.

Approximately ⅓ of infertile cases involve the male. Problems with sperm output can be affected by unrelated diseases like diabetes or a variety of STDs. Genetic deformities in male reproductive organs have proved to disturb fertility as well.

Another ⅓ of cases involve the female. Advanced age puts women at higher risk of infertility as less eggs are readily available. Older women are also more susceptible to complications in unassisted pregnancy. A more uncommon cause is damaged fallopian tubes which can be caused by pelvic inflammatory disease or prior pregnancy complications.

The last ⅓ of cases involve factors that affect both genders. Cancer has an impact directly and indirectly. Cancerous bodies that physically sit on reproductive organs can affect fertility. However, the most significant effect arises from indirect effects. The first is treatment like radiation or chemotherapy. This can blunt sperm production and damage its health too. Environmental effects include overexposure to toxic substances such as smoking, alcohol, or drugs, all of which can affect one’s health and subsequently one’s ability to reproduce. Finally, cases do exist that are left unexplained, which illustrates the foreign nature of this topic.

WHAT ARE THE RISKS?

In vitro fertilization has its benefits but with any good thing comes the costs and risks. IVF does not have a set price as insurance coverage varies but the cost hovers around $15,000 and can increase with more medication or complications. The costliness can be attributed to the variety of infertility treatments available. I hope that in the future, as more efficient and cheaper methods are researched, this number goes down because infertility is mostly unpreventable and affects people with different socioeconomic statuses. It seems unfair that fertility is only available to those who can afford it.

IVF is also a risky process with invasive procedures and unpredictable results. First, there is a risk that pregnancy doesn’t result at all. There are several risks flagged with each step as well that can affect the result. For example, the transfer of embryos is deemed to be more successful with more developed embryos. Lifestyle factors such as smoking, alcohol, or drugs can also affect IVF through the egg, sperm, or pregnancy.

In addition, there are extensive side effects that accompany the stages of IVF. There are hormonal side effects that can prompt bloating, cramping, mood changes, and headaches. Medication side effects can trigger allergic reactions. Finally, there are bleeding and infection risks with any surgery or invasive procedure. So, it’s important to assess whether the benefits outweigh the costs before deciding to begin the process.

AN IVF NARRATIVE

I interviewed a couple, Patient A and B, who are now in the “I’m Done” stage in their reproductive journey. While they did reach their desired family planning goal, there were bumps along the road that steered them towards unconventional methods to reach their destination.

The couple had a desired but flexible goal of three kids as they understood the uncertainty interlaced with family planning and health in general. They had a child in 2003 through an unplanned cesarean and were one step closer towards their end goal. Shortly afterwards, Patient A was diagnosed with Non-Hodgkin’s Lymphoma, which is a cancer that affects your lymphocytes and immune system. Cancer is an unpredictable evil that affects nearly 39.5% of people in their lifetime, according to the National Cancer Institute. No one expects it to interrupt their life plan and certainly no one plans for it. Once made aware of the diagnosis, family planning was no longer on their minds, but the simple privilege of survival was.

The day before beginning treatment, they were advised to bank Patient A’s sperm because after radiation and chemotherapy, his sperm may no longer be viable. So, the couple went on to bank the sperm and set it aside for later in their journey. They wanted to keep the option open, but family planning was not near the top of their priorities at the time.

“I never considered this option; I never thought I even had an option. It wasn’t on my mind anymore, but it was worth it to us if there was a possibility”.

-Patient A

Patient A went on to beat cancer and continued to stride on with a more appreciative perspective of those around him. After furthering their careers and taking time to grow as a family of 3, the couple decided to pursue infertility treatments. They had considered other treatments but never questioned their decision to pursue IVF. They were advised that it was the most efficient and purposeful method with the limited odds they had. They were aware of the risks and unpredictability in the process but in the end, they decided to try. “We had to be okay with it not being successful. We were blessed with one already. It was a privilege to have the opportunity to do this too”.

As they began, the collection and implanting steps were successful. From this point on, Patient A and Patient B played different roles in the process. Patient A, as the male, gave Patient B her injections and took care of her during her pregnancy. However, he felt an overwhelming sense of responsibility for pursuing this option in the first place. “I had no physical risk. I’m watching [Patient B] go through procedures and mentally enduring the process; it was stressful to watch”.

Patient B, juggling the roles of a working mother and patient, had a more burdensome experience, both mentally and physically. ‘'My story’s a little different than most women. I already had a pregnancy and am thankful for that. This was the quiet phase”. Most women undergoing IVF treatment were trying for their first child so Patient B was a less common circumstance.

In the end, the couple was blessed with a healthy baby boy and were overwhelmed with happiness and fortunate to be a success story of IVF. While they didn’t reach their original goal, goals can change, and it is also important to recognize that as you approach obstacles. When considering trying again, Patient B “didn’t want to tempt fate. We were blessed, so we stopped at 2”. After asking if they would have chosen a different path after undergoing IVF, they had one simple answer:

“We counted 10 fingers and 10 toes on our baby and never looked back. We thought of it as a normal step in our life and are beyond grateful for the opportunity.”

CONCLUSION

IVF may be a step in your reproductive journey, and it is a step that you can choose to explore. At RepLI, we believe your reproductive life should happen for you, not to you. After all, you only have one journey so why not take the opportunity to design it yourself rather than leave it to chance?

REFERENCES

1. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

2. https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf

3. https://www.cdc.gov/art/whatis.html

4. https://medlineplus.gov/ency/article/007279.htm

5. https://www.kofinasfertility.com/patient-info/3-fertility-treatment-options-before-ivf

6. https://www.cancer.gov/about-cancer/understanding/statistics#:~:text=Approximately%2039.5%25%20of%20men%20and,on%202015%E2%80%932017%20data).

IMAGES

1. https://www.healthline.com/health-news/children-born-via-ivf-face-higher-health-risks

2. https://dhcivfthai.com/wordpress/en/project/iui/

3. https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q02-what-causes-infertility/

4. https://medium.com/design-ibm/design-and-decision-making-ead94782ec75